Dextromethorphan (DXM) Misuse

Dextromethorphan (DXM) is a substance found in cough syrups and cold medications that works to help suppress cough. It has a high potential for misuse and is often combined with other drugs. Many people misuse DXM to produce euphoric effects and may experience auditory and visual hallucinations.

On this page, you will learn what DXM is, the dangers and side effects of dextromethorphan misuse, if DXM is addictive, whether you can overdose on dextromethorphan, and how to get treatment for DXM misuse.

What Is Dextromethorphan (DXM)?

Dextromethorphan, also known as DXM, is a synthetic drug found in over 140 over-the-counter cough suppressants and cold medications.¹ DXM is in a class of drugs called antitussives because it helps suppress cough.² It is similar in chemical structure to codeine, an opioid, but it does not act on the opioid receptor or produce opioid effects and therefore is not an opioid.^3,4 DXM is commonly misused because in high doses it can produce feelings of euphoria, hallucinations, and out-of-body experiences (dissociation). 

Common street names for DXM include:⁵

A typical prescribed or over-the-counter dose of DXM cough syrup is 15–30mg, 3–4 times daily.⁵ When people misuse DXM, they may take 250–1500mg in a single dose.⁵

Some people use DXM by combining it with soda to enhance the flavor and/or drinking large volumes, which is called “skittling” or “robo-tripping.”^3,5 When people use DXM, they may also combine it with other substances such as alcohol or marijuana.³ People may also mix DXM with pseudoephedrine or methamphetamine.⁵

What Is DXM Used For?

DXM is a common ingredient in cold and cough medications. People use it recreationally for its euphoric effects. DXM comes in tablets, powder, capsules, or cough syrup. Products containing DXM can be purchased over-the-counter at many supermarkets or grocery stores, and powder is often ordered online.⁵ The most misused medications containing DXM are Robitussin and Coricidin HBP.⁵

How Is DXM Misused?

DXM can have depressant and hallucinogenic effects, similar to those of PCP and ketamine.³ Many people misuse DXM by taking it in large doses, which produces euphoric effects or visual and auditory hallucinations.⁵

Side Effects and Dangers of Misusing DXM

DXM is relatively safe when taken as directed and has few side effects.¹ However, if you misuse DXM, you are putting yourself at risk for many side effects and dangers.

Typical effects that may occur when you misuse DXM include:³

If you use high doses of DXM with other drugs or alcohol, it can be incredibly dangerous and potentially deadly due to the combination of effects it can have on the body.⁵ The Drug Enforcement Administration (DEA) reports that 5–10% of caucasian people metabolize DXM poorly.⁵ Ingesting large amounts of DXM can cause you to go into a dissociative state, similar to what one might experience if one were using ketamine or phencyclidine (PCP).^3,5

When using DXM, people experience its effects in various intensities. These differing effects are known as plateaus.⁶

The plateaus are as follows:⁶

• Plateau 1: Ingestion of 100–200mg; People at this plateau may experience euphoria and restlessness.
• Plateau 2: Ingestion of 200–500mg; People at this plateau may experience hallucinations, heightened auditory and visual sensations, and imbalance.
• Plateau 3: Ingestion of 500–1000mg; People at this plateau may experience mania, panic, intense auditory and visual disturbances, delayed reactions, altered consciousness, and partial dissociation.
• Plateau 4: Ingestion of more than 1000mg; People at this plateau may experience hallucinations, delusions, total dissociation, and loss of coordination.

If you misuse DXM, there is a possibility of overdose and death.³ If you’re having trouble stopping the use of DXM, you may consider seeking treatment, which can help you stop using and improve your overall quality of life.

The phenomenon known as “pharming” is when people misuse over-the-counter or prescription drugs to gain a desired effect.⁷ Pharming can lead to many negative consequences, including:⁷

• More emergency room visits.
• Increased treatment admissions.
• Dangerous behavior.
• Drug-related deaths.
• Overdoses due to OTC drug use.

Is Dextromethorphan Addictive?

While DXM is not considered addictive, chronic dextromethorphan use has the potential for tolerance and dependence in vulnerable individuals.⁷ DXM users often experience psychotropic effects similar to alcohol when they use it.²

Can You Overdose on Dextromethorphan?

Yes, you can overdose on dextromethorphan, especially if you’re taking large quantities or with other substances.³ If you take a large amount of DXM, it can produce life-threatening reactions or toxicity. It is important to note that most DXM overdose deaths occur when DXM is mixed with other substances.³ When you overdose, your breathing can slow or stop, which decreases oxygen to your brain, in a condition known as hypoxia.³ Hypoxia can cause permanent brain damage, coma, or death.³

Symptoms of DXM Overdose

If someone is experiencing an overdose you should call 911 immediately.³ The quicker you take action, the less detrimental the effects may be on the person experiencing the overdose.

Some common symptoms of DXM overdose include:⁸

DXM overdose can occur as a result of other substances as well; since DXM is found in many cough and cold medications, there are additional ingredients in these medications that can cause an overdose.⁵ Some cough formulations contain chlorpheniramine, acetaminophen, and pseudoephedrine, which can also cause overdose.⁵

In a couple of cases, naloxone has been shown to help reverse a DXM overdose; however, studies are inconclusive as to whether naloxone is an antidote for DXM overdose. Regardless, administering naloxone does not cause harm so it may be beneficial to administer in overdose cases, especially if there are suspected opioids involved. Anyone can administer naloxone in the event of an overdose; instructions for naloxone administration are included with the packaging.

Detoxification for DXM

If you develop a physical dependency to DXM and are at risk of potentially experiencing withdrawals, you can undergo detox to help you discontinue use and manage withdrawal symptoms under medical supervision.

Some goals of DXM detox may include:^2,8 

• Recognition or admission of dependence on DXM.
• Social stabilization.
• Continued treatment.

Treatment for Dextromethorphan Misuse

While there aren’t any medications that help treat DXM misuse, many people find that inpatient care, behavioral therapy, or both can help them recover.³ Behavioral therapy can help you change your attitudes and behaviors toward drug use and learn how to handle stress and prevent relapse.⁹

Cognitive behavioral therapy can help you recognize negative patterns of thinking, educate you on relapse, and help you learn new coping skills.⁹ Contingency management is a reward system that rewards you for drug-free behaviors and is used in some treatment centers.⁹

If you or a loved one misuses multiple substances (e.g., DXM with alcohol or marijuana), this is known as polysubstance use. Individuals using more than one substance at a time may benefit from an inpatient addiction treatment and/or outpatient rehab programs, as well as addiction recovery support groups and rehab aftercare.  

Find Help for DXM Misuse 

If you’re seeking addiction treatment for hallucinogenic drugs likeDXM, drug rehab can help you start the path to a better life. When you begin treatment, you start learning about how to abstain from using drugs and alcohol and how to improve your coping skills. You may also learn strategies to help prevent relapse.

American Addiction Centers (AAC) offers treatment for alcohol and drug misuse at its centers. If you’re considering starting treatment, you can call our team of compassionate admissions navigators at to learn more about your treatment options or to verify your health insurance coverage.

If you’re having challenges with DXM misuse, don’t delay; make the call today.